Provider Notice issued 11/10/15

Annual Rate Changes Effective October 1, 2015

The Centers for Medicare and Medicaid Services (CMS) recently notified the Department of the annual update of Medicaid hospice rates for federal fiscal year 2016. Medicaid hospice rates are calculated based on the annual hospice rates established under Medicare. These rates are authorized by Section 1814(i)(1)(C)(ii) of the Social Security Act, which also provides for an annual increase in payment rates for hospice care services.

Revised rates for continuous home care, inpatient respite care, and general inpatient care will be effective for claims with dates of service from October 1, 2015, through September 30, 2016. The revised rate for routine home care is effective for claims with dates of service from October 1, 2015 through December 31, 2015. The Department will provide additional information at a later date regarding future rate changes for routine home care.

The annual hospice rate update is posted to the Department’s website. This site provides the following information:

• A table identifying each Illinois county and its assigned Core-Based Statistical Area (CBSA), and corresponding wage index.

• Revised rate components (wage component and unweighted amount) to be used in the calculation of rates for all four types of hospice care.

• The formulas for calculating all four types of hospice care payments, and examples.

Payment for all types of hospice care is based upon the geographic location (CBSA) where the service is furnished.

• Hospice providers must use Value Code 61 with the appropriate CBSA on their claims to identify the location where the Routine Home Care (Revenue Code 651) or Continuous Home Care (Revenue Code 652) services were provided. The CBSA must be placed right justified to the left of the dollar/cents delimiter. If the patient resided in more than one CBSA during a billing period, the last CBSA should be reported on the claim for payment. If more than one Value Code 61 is reported on the claim, the claim will reject.  

• Hospice providers must use Value Code G8 with the appropriate CBSA to identify where the inpatient facility is located to report on claims containing Inpatient Respite Care (Revenue Code 655) or General Inpatient Care (Revenue Code 656). The CBSA must be placed right justified to the left of the dollar/cents delimiter. If multiple inpatient locations with differing CBSAs are used in a billing period, the last CBSA should be reported on the claim for payment. If more than one Value Code G8 is reported on the claim, the claim will reject.

If a hospice provider needs to bill a CBSA that is not identified on the website table, please contact the hospice’s billing consultant at the Department. The Department will need to add the CBSA to the Department’s database in order for the claim to process correctly.

Note: The billing instructions in this notice apply to patients enrolled in traditional fee-for-service, Accountable Care Entities (ACEs), and Care Coordination Entities (CCEs), and do not apply to patients enrolled in Managed Care Organizations (MCOs) and Managed Care Community Networks (MCCNs).

It is imperative that providers check HFS electronic eligibility systems regularly to determine beneficiaries’ enrollment in a plan. The Recipient Eligibility Verification (REV) System, the Automated Voice Response System (AVRS) at 1-800-842-1461, and the Medical Electronic Data Interchange (MEDI) system will identify any care coordination plan in which the beneficiary is enrolled. Plan contact information for questions related to coverage and billing requirements, as well as information regarding the way each plan is displayed in the Department’s electronic eligibility systems may be located in the March 9, informational notice titled, Care Coordination Health Plan Identification and Billing Procedures Depending on Health Plan Enrollment.

Any questions regarding this notice may be directed to your billing consultant in the Bureau of Hospital and Provider Services at 1-877-782-5565.

Felicia F. Norwood

Director